Ask Dr. K: Finding source of chest pain

Dear Dr. K: I'm a 38-year-old woman. I recently saw my doctor about a sharp pain that comes and goes in the middle of my chest. She assures me my heart is healthy. What could be causing my discomfort?

Dear Reader: The first thing your doctor worries about if you have chest pain is heart disease, which can be life-threatening. Fortunately, other, less serious conditions cause chest pain more often. But the first thing to be ruled out is heart disease, and it's good news that it was.

So what caused your chest pain? There are many possibilities, but from your brief description I suspect a different culprit: costochondritis, an inflammation of the costochondral joints. These are the joints that join your ribs to your breastbone (sternum). (I've put an illustration on my website, AskDoctorK.com.)

The main symptom of costochondritis is sharp, stabbing or aching pain along the front edges of the breastbone. The pain may be felt in more than one spot; it may radiate to the back or abdomen or spread down the arm, one reason why it's often mistaken for a heart attack.

Costochondritis worsens when you move your torso, take deep breaths or cough. Physical exercise can also aggravate it.

Costochondritis often results from unusually stressful physical activity or traumatic injury. It can also be caused by respiratory infections, which can inflame the costochondral joints. Strain from coughing can produce the condition. In most cases, however, there is no obvious cause.

To diagnose the condition, your doctor will apply pressure to the joints where the ribs meet the breastbone, in the part of the chest where you feel pain. If that pressure causes pain, and pressure in other areas of the chest away from the joints does not, you probably have costochondritis. Rarely, a joint where a rib meets the breastbone is swollen, warm and red, as well as tender. That's a sign of an unusual condition called Tietze's syndrome.

Nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen and naproxen are usually effective. You can also try pain-relieving creams, which you apply directly on your skin. Two types of creams are used most often: those containing aspirin and those containing capsaicin. Cool compresses or heating pads and stretching exercises may help. For women, wearing a special support bra may provide some comfort.

Avoid activities that aggravate the symptoms. For example, wearing a sling-style purse or backpack may worsen the pain.

With treatment, symptoms should begin to ease within a week. If your pain doesn't respond to medications and conservative treatment, your doctor may suggest a steroid injection.

Even without treatment, most cases go away, although that may take several months. The condition doesn't cause any long-term problems and is unlikely to return. Costochondritis is just one of those minor maladies that plague us but don't threaten us.

Dr. Komaroff is a physician and professor at Harvard Medical School. Go to his website to send questions and get additional information: www.AskDoctorK.com.